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Helping Americans Eat More of

the Good Stuff

A Systems-Wide Approach to Increasing

Fruits and Vegetables and the Impact on

Public Health, the Economy and the Environment

March 2015

Helping Americans Eat More of the Good Stuff 2

Eat More Fruits and Vegetables: It’s Good For You … and For

All of Us

Eat more fruits and vegetables. For more than 50 years

healthcare professionals have made that simple recommendation to

help patients stay healthy, and the American Heart Association has

made it a centerpiece of its advice to improve the nation’s health.

This recommendation is as true today as it was five decades

ago because science continues to show health benefits. Fruits and

vegetables help people reduce low-density lipoproteins (more

commonly known as “bad” cholesterol), lower blood pressure and

maintain healthy weight.1

Fruits and vegetables, as part of a healthy overall dietary

pattern, can substantially lower risk for cardiovascular diseases,

stroke, diabetes and other health problems. These benefits are

proven in diets emphasizing fruits and vegetables, whole grains,

low-fat dairy products, poultry, fish, legumes, non-tropical

vegetable oils and nuts – but limited in sweets, sodium, sugar-

sweetened beverages and red meats. Increasing fruit and vegetable

consumption alone can reduce the risk of cardiovascular diseases

and stroke by 20 percent.2

Based on this compelling evidence, the American Heart

Association recommends adults eat 4-5 servings of fruit and 4-5

servings of vegetables per day.3 (That comes out to approximately

4½ cups of each.) This is similar to the recommendations in the

1 2013 AHA/ACC Guideline on Lifestyle Management to Reduce Cardiovascular Risk, A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines, Management to Reduce Cardiovascular Risk. 2013. http://circ.ahajournals.org/content/suppl/2013/11/07/01.cir.0000437740.48606.d1.DC1 2 He, F.J., et al., Increased consumption of fruit and vegetables is related to a reduced risk of coronary heart disease: meta-analysis of cohort studies. J Hum Hypertens, 2007. 21(9): p. 717-28. 3 http://www.heart.org/idc/groups/heart-public/@wcm/@fc/documents/downloadable/ucm_467681.pdf


federal government’s Dietary Guidelines for Americans. 4 Even

when people can’t reach those totals, there are benefits to eating

fruits and vegetables. Just 2½ cups of fruits and vegetables per day

could reduce the risk of heart attack and stroke.5

Getting people to eat enough fruits and vegetables has been

a problem historically. By 1999, it became clear that education

efforts could only go so far, and that more work is needed to

overcome the barriers of access, affordability and appeal. For nearly

15 years, intake levels have been at about half the recommended

intake, various studies have found. Here is as quick look at some of

those findings:

Average U.S. Per Capita Fruit and Vegetable Consumption in

Cups

4Dietary Guidelines for Americans 2010. U.S. Department of Agriculture and U.S. Department of Health and Human Services, 2010 http://www.cnpp.usda.gov/sites/default/files/dietary_guidelines_for_americans/PolicyDoc.pdf

5 Dietary Guidelines for Americans 2010. U.S. Department of Agriculture and U.S. Department of Health and Human Services, 2010. http://www.cnpp.usda.gov/sites/default/files/dietary_guidelines_for_americans/PolicyDoc.pdf

1.82

NHANES 2009-20101

NPD Group 20092

1.09 1.06 2.35

0.69 1.13 2.68

2.15

Recommended Amount

4.5

Fruits Vegetables* Under

Consumption

Key

1.96

USDA ERS 20092 0.85 1.11

2.54


The National Health and Nutrition Examination Survey

(NHANES), performed by the National Center for Health Statistics

at the Centers for Disease Control and Prevention since the 1960s,

estimates current intake at 2.15 cups per day based on its survey of

the dietary intake of 5,000 individuals. 6 NHANES is widely

accepted as an accurate estimate of dietary intake by the public

health and nutrition community. Historic NHANES estimates may

have been low based on prior underreporting of actual intake.

The Produce for a Better Health Foundation found that average

consumption has held relatively steady since 1999, at a slightly

lower level of between 1.75 and 1.83 cups per day. That finding is

based on an analysis of the NPD Nutrient Intake Database that tracks

the self-reported eating habits of 5,000 individuals, a study

performed since 1980. The NPD Group (formerly the National

Purchase Diary) is a private company that has tracked consumer

behaviors and retail sales since 1967.

The Economic Research Service of the U.S. Department of

Agriculture (ERS) publishes an ongoing estimate of fruit and

vegetable consumption in the U.S. based on the availability of fruits

and vegetables. That estimate shows a higher level of availability, at

over 2½ cups, before accounting for waste and spoilage. It also

shows a greater rate of increase until 1999, followed by a decline.7 8

6 NHANES 2009-2010, Individuals age 2+ years, day 1 dietary intake date, weighted. Food Patterns Equivalents Database (FPED) 2009-2010. 7 U.S. Department of Agriculture Economic Research Service, Fruits and vegetables (fresh weight equivalent): Per capita availability, 1970-2012. http://www.ers.usda.gov/data-products/food-availability-(per-capita)-data-system/.aspx 8 U.S. Department of Agriculture Economic Research Service, Average daily intake of food by food source and demographic characteristics, 2007-10, http://www.ers.usda.gov/data-products/food-consumption-and-nutrient-intakes.aspx


No matter which data are used, fruit and vegetable

consumption remains well below recommendations associated with

optimal health. The low levels of fruit and vegetable consumption,

despite consistent recommendations and persistent health

messaging, shows the need for a new and innovative approach in the

U.S. and worldwide.

Fruit and Vegetable Availability per Person in Pounds9

Meanwhile, the annual cost of health care has risen in the

U.S. to $2.8 trillion, or nearly 18 percent of gross domestic product,

the highest among Western countries.10 Nearly 70 percent, or about

$2 trillion, is spent to treat lifestyle-related diseases, and diseases

associated with dietary risk now account for 26 percent of all deaths

in the U.S.11 Private spending on health care also is the highest

9 Bentley, Jeanine, Food Availability (Per Capita) Data System, U.S. Department of Agriculture Economic Research Service, December 2014, http://www.ers.usda.gov/data-products/food-availability-(per-capita)-data-system/.aspx 10 Noreen, Cliff, 2014 Economic & Market Update, Tower Square Capital Partners Annual Meeting Babson Capital Management, LLC. May 6, 2014 11 The State of US Health, 1990-2010: Burden of Diseases, Injuries, and Risk Factors US Burden of Disease Collaborators, JAMA. 2013;310(6):591-606. O’doi:10.1001/jama.2013.13805

0

100

200

300

400

500

600

700

800

1970 1975 1980 1985 1990 1995 2000 2005 2010Po

un

ds

Ava

ilab

le P

er P

erso

n P

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Yea

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Fruits Vegetables Total


among Western nations, at a time when average household incomes

have declined.12

Over these same years, agricultural and livestock production

have caused significant environmental problems. In the U.S., the

average rate of red meat consumption is far above the global average

and among the highest in the world.13 Emissions from agricultural

and livestock production processes have contributed to climate

change, 14 and livestock and their feed have degraded water

resources.

On the other hand, diets with more fruits and vegetables and

lesser amounts of other foods, notably animal proteins, can benefit

the U.S. economy. Such a diet also would lessen the burden on the

environment sooner than other measures, such as changing the

power, transportation or water infrastructure.

This importance of food to our health, environment and

economy is well established in the scientific literature, and changes

in dietary patterns are associated with diverse impacts across

multiple sectors. The Institute of Medicine recently established A

Framework for Assessing Effects of the Food System to inform

understanding of these broad yet integrally interconnected

12 Noreen, Cliff, 2014 Economic & Market Update, Tower Square Capital Partners Annual Meeting Babson Capital Management, LLC. May 6, 2014

13 FAO 2013, Current Worldwide Annual Meat Consumption per capita, Livestock and Fish Primary Equivalent, Food and Agriculture Organization of the United Nations, viewed 31st March, 2013, http://faostat.fao.org/site/610/DesktopDefault.aspx?PageID=610#ancor.

14 Ta Gerber, P.J., Steinfeld, H., Henderson, B., Mottet, A., Opio, C., Dijkman, J., Falcucci, A. & Tempio, G. 2013. Tackling climate change through livestock – A global assessment of emissions and mitigation opportunities. Food and Agriculture Organization of the United Nations (FAO), Rome. http://www.fao.org/3/8d293990-ea82-5cc7-83c6-8c6f461627de/i3437e.pdf


relationships.15

The framework provides decision makers with a basis to

understand and analyze effects, weigh tradeoffs and guide decision

making within the complicated and dynamic food environment. This

work supports and drives the American Heart Association’s decision

to initiate a “systems approach” and coordinated planning effort

across multiple sectors including health care, environment,

conservation, private investment, food and agriculture to develop a

blueprint that will increase fruit and vegetable intake by an average

of 2½ cups per person over the next decade.

Mind the Gap

Moving toward a diet that includes 4½ cups of fruits and

vegetables per day – while reducing consumption of red meats,

refined grains, sodium, added sugars and sugar-sweetened

beverages – can deliver benefits to our health, the health of our

economy and the health of our planet.

The fact that consumption of fruits and vegetables has

stagnated since 1999 may show the limits of public awareness

efforts by themselves. But they also may be a reflection of the

changes in the way we eat.

Americans are eating fewer meals prepared at home and

have nearly doubled spending on meals prepared by food industry

professionals. Nearly half of our food dollars are spent on prepared

meals rather than uncooked individual items, such as fresh fruits and

vegetables.16

15 Nesheim, Malden C., et al, A Framework for Assessing Effects of the Food System, Institute of Medicine National Academies Press, 2015. 16 Changing Tastes analysis of USDA annual food expenditures studies, 1954-2012 and National Restaurant Association annual reviews, 2007-2012.


Share of Household Food Expenditures on Meals Away from

Home17

The way we buy fruits and vegetables also has changed.

Grocery retailers now offer restaurant-style meals, which have

become the fastest-growing part of their stores. That means stores

and restaurants – not individual consumers – are making more of the

decisions about where fruits and vegetables fit into a meal.

Grocery retailers also have increased their emphasis on

seasonal offerings, importing a wider variety of fruits and vegetables

during their peak growing seasons. Also, offerings have grown

among branded fresh and frozen products. And there has been an

even more dramatic increase in easy-to-serve products such as

bagged salads and precut fruits and vegetables. Both provide higher-

quality nutrition and convenience, replacing the need to buy several

kinds of fresh, whole or minimally processed produce.

All of this selection and convenience adds value for the

consumer, but it has come at increased cost. Spending on fruits and

17 U.S. Department of Agriculture Economic Research Service annual food expenditures studies, http://www.ers.usda.gov/topics/food-choices-health/food-consumption-demand/food-away-from-home.aspx

0

10

20

30

40

50

1970 1975 1980 1985 1990 1995 2000 2005 2010

Sh

are

of

Ho

use

ho

ld F

oo

d

Exp

end

itu

res


vegetables has grown, however, the spending has been for more

convenience than for more fruits and vegetables.18

Increasing Capacity and Food System Challenges

Fruit and vegetable production has undergone significant

change, with the continued expansion of production scale

agriculture in California, which now supplies the largest share of

many popular fruits and vegetables.

Share of Popular Fruits and Vegetables from California19

California’s primary agricultural regions have suffered from

an intensive, multi-year drought in recent years. This has forced

farmers to turn to groundwater resources to make up the shortage in

rainfall, depleting the state’s water reserves and driving up prices.

This drought has been long predicted by climate scientists, and

18 Bentley, Jeanine, Food Availability (Per Capita) Data System, U.S. Department of Agriculture Economic Research Service, December 2014, http://www.ers.usda.gov/data-products/food-availability-(per-capita)-data-system/.aspx 19 U.S. Department of Agriculture Economic Research Service, California Drought 2014: Farm and Food Impacts, 2014. http://ers.usda.gov/topics/in-the-news/california-drought-2014-farm-and-food-impacts/california-drought-2014-crop-sectors.aspx#caveggiesandmelons

88%

88%

91%

74%

91%

95%

73%

98%

95%

94%

75%

0% 20% 40% 60% 80% 100%

Apricots

Avocadoes

Strawberries

Rasberries

Grapes

Nectarines

Peaches

Plums

Broccoli

Celery

Lettuce


growing conditions are unlikely to improve for at least several

decades, if ever.

Palmer Modified Long-Term Drought Index20

The combination of climate change and increased reliance

on California’s agricultural sector have made the nation’s annual

harvest of fruits and vegetables less certain, while driving up price

volatility.

The Next 2½ Cups

An effective strategy to close the fruit-and-vegetable gap

over the next decade must improve all aspects of our food system.

Several new approaches have emerged, including new

business models for farm-direct sales, prescriptions for fruits and

vegetables, the expansion of agricultural production to other parts of

the country, innovations in technologies to enhance growing

conditions and extend growing seasons, private and public sector

20 National Drought Information System, November 2014, http://www.drought.gov/drought/content/what-nidis/trackback


purchasing policies, and commitments by larger restaurant and

foodservice companies to serve more fruits and vegetables.

There also has been an increase in innovation among public-

sector efforts, notably the substantial changes in school lunch

programs along with financial incentives for the purchase of fresh

fruits and vegetables such as the SNAP pilot “double up food bucks”

program. But most of these efforts are pilot programs and receive

modest levels of funding and support, or they are in the early stages

of implementation.

While showing great promise, no single effort has

significantly increased consumption. Taken together, they show the

greater potential of efforts that work to simultaneously improve

production and access, along with continued public awareness and

education efforts.

Which Comes First: The Fruit or the Seed?

While the public health community’s primary focus has been

to increase awareness, others have worked to improve agricultural

conditions and increase access to fruits and vegetables.

All have achieved some level of success and relied on some

common approaches, including improving public policy and

educating the public while also seeking to leverage the powerful

influence of private investment, medical expertise, and consumer

media and marketing channels.


Public and Private Sector Efforts to Promote Public Health,

Agricultural Production and Economic Development Impact

Fruit and Vegetable Consumption

The success in each arena has come in part from the periodic

intersection of efforts to shape public policy, influence business and

investment decisions, and affect the system that provides

production, access and demand for fruits and vegetables.

Keys to a Successful Harvest

Increasing fruit and vegetable consumption in the U.S. by

about 2½ cups per day per person will require a new, breakthrough

strategy. This approach must involve a systems-wide approach and

coordination among leaders in public health, health care, public

policy, finance and business.

A wide variety of stakeholders will benefit significantly

from improvements in our nation’s health, the economy and the

environment. The keys to success are to drive change in existing

Fruit and Vegetable Consump on

Increase Demand

Increase Access and Affordability

Grocery Retail

Food Service

Private Sector Business & Investment Public & Civic Sector

Private Sector Business & Investment Public & Civic Sector

Agriculture Incen ves & Subsidies

Marke ng Media Healthcare Public Health


systems and to promote innovative approaches at a time of growing

risks to the nation’s health, economy and the environment.

Rising risk can be seen as a reason not to change. But

increasing fruit and vegetable consumption has the unique power to

help reduce these very risks. A new strategy must work to improve

the food sector in several key areas, including:

Fruit and Vegetable Production

Increase the ability to produce and supply a larger share of U.S.

fruits and vegetables.

The U.S. grows crops on 408 million acres of land, 10.7 million of

which are devoted to fruits and vegetables. If that acreage were

increased by 50 percent (16.1 million acres), the U.S. could produce

enough fruits and vegetables for Americans to consume

recommended levels, according to the Union of Concerned

Scientists.21 That represents a change of 1 percent to 2 percent of the

nation’s crop acreage. That is less than the amount of cropland that

could be freed up from producing animal feed with even a modest

reduction in red meat consumption of less than one half serving per

day.22

21 Union of Concerned Scientists, The Healthy Farmland Diet Report, October 2013 http://www.ucsusa.org/sites/default/files/legacy/assets/documents/food_and_agriculture/healthy-farmland-diet.pdf

22 Changing Tastes, 2014.


Growing Enough Fruits and Vegetables Requires a Small Shift

in How U.S. Farmland is Used — Union of Concerned

Scientists21

Increasing fruit and vegetable production while adjusting to

new growing conditions creates a new investment opportunity.

Delivering a more dependable harvest under changing growing

conditions, including more volatile weather and declining

freshwater resources, will require expanding fruit and vegetable

production beyond just a few parts of the country.

Public policy changes that better align agricultural

incentives and supports with the nation’s dietary needs for better

public health will speed the increase of fruit and vegetable

production while helping to reduce cost for consumers and

businesses. 23 This includes important changes in existing crop

promotion programs to allow farmers to grow fruits and vegetables

23 Balagtas, J.V., B. Krissoff, L. Lei, and B.J. Rickard. 2014. How has U.S. farm policy influenced fruit and vegetable production? Applied Economic Perspectives and Policy 36(2): 265-286.

391.9

10.7 5.4

Remaining U.S. Cropland(in millions of acres)

Current U.S. F&V Acreage(in millions of acres)

Increase Needed in U.S. F&V Acreage Under Diet Shift(in millions of acres)


as well as other commodity crops without foregoing public

incentives and supports.

It will require expanding processing and distribution

equipment and capacity in new areas, creating opportunities for

investment in many parts of the country. Improving the processing

and distribution system will reduce the amount of food waste; today

fresh and perishable fruits and produce often spoil before being

used.

These improvements also will help to reduce the price of

fruits and vegetables, a substantial barrier to consumption.

Raising domestic production rates to match the

recommended dietary patterns is critical to avoid the international

price impacts from boosting U.S. prices along with adverse impacts

on the today diets of other countries.24

Grocery Retail and Foodservice

Increase access and consumption of fruits and vegetables.

Improving access will require a change in the foods provided

by both the grocery retail and the foodservice segments, with each

now providing a similar share of the nation’s diet.

Both sectors must continue innovation in their menus and

recipes and increase the convenience of eating fruits and vegetables.

This includes specific changes to include fruits and vegetables more

often in more dishes, rather than segregating them in to separate

parts of their food offerings.

The continued expansion of brand marketing strategies to

fruits and vegetables also leverages proven methods to shift

purchasing habits in grocery retail. Similarly, the expansion of

24 O’Hara, Jeffrey, unpublished communication, 2014.


public policies and incentives to increase the availability of fruit and

vegetables especially in noncommercial foodservice venues, such as

public schools and government dining halls can increase access

while providing guaranteed demand to support the expansion of fruit

and vegetable production in new parts of the country.25 26 27

Both segments also can leverage new strategies around

choice architecture, combining information technology and physical

design to change the ways consumers decide where to get food and

what they choose to eat.28

The increase in fruit and vegetable production across the

country, coupled with reduced time from harvest to sale, contribute

to the success of these new business efforts. This scenario also

matches the grocery shopper’s growing interest in fresh and local

foods while significantly improving the economics of increasing the

use of perishable foods.

25 Pansing, et al, Roadmap for City Food Sector Investment and Innovation, City of San Francisco Planning Department, 2013. http://www.sf-planning.org/index.aspx?page=3540

26 Dong, D., and E. Leibtag. 2010. Promoting fruit and vegetable consumption: Are coupons more effective than pure price discounts? ERR 96. Washington, DC: USDA Economic Research Service.

27 Klerman, J.A., S. Bartlett, P. Wilde, & L. Olsho. 2014. The short-run impact of the healthy incentives pilot program on fruit and vegetable intake. American Journal of Agricultural Economics 95(5):1372-1382.

28 Just, D.R., J. Lund, and J. Price. 2012. The role of variety in increasing the consumption of fruits and vegetables among children. Agricultural and Resource Economics Review 41(1): 72-81.


Health Care and Health Advice

Leverage medical advice and health and wellness incentive

programs to promote increased consumption of fruits and

vegetables.

Public health education and medical advice continue to be

important supports for fruit and vegetable consumption, requiring

the continued efforts of researchers and practitioners.

Recent research studies have shown that eating healthy and

particularly, fruits and vegetables consumption can have a

significant improvement in health.29 Furthermore, U.S. businesses

are increasingly seeing the value of healthy foods in the workplace

and improved productivity in the labor force while reducing costs in

health care.30

Changes in the U.S. model of healthcare provision and

structural changes in the healthcare industry offer new opportunities

to align financial incentives at all levels with increasing fruit and

vegetable consumption.

Individuals can be rewarded for eating more fruits and

vegetables through expansion of incentives such as the “Double Up”

program for SNAP recipients, individual tax and other savings from

fruit and vegetable prescription programs, and workplace programs

to offer fruits and vegetables to eat at home at a reduced costs.

Healthcare companies can realize lower costs from improving the

health of their client populations, including the cost of treating

chronic diseases related to dietary intake.

29 Chatterjee A. and Kubendran, S. Drink Different: Feasible Strategies to Reduce Obesity, Milken Institute, 2015. 30 Goetzel RZ, Henke RM, Tabrizi M, et al. Do workplace health promotion (wellness) programs work? J Occup EnvironMed. 2014;56(9):927-934.


Health insurance companies also can realize similar benefits by

incenting and investing in efforts to increase fruit and vegetable

consumption.

Aligning healthcare programs will also require continued

research into the impacts of dietary change in individuals and large

populations.

Medical and nutrition professionals also must continue to be

the most trusted sources of advice on what to eat.31 The profession

will need to continue to emphasize what to eat, not just what to

avoid. Increasingly, healthcare professionals can reach broader

audiences through mainstream and social media, and provide the

same advice.

Closing the Gap

Achieving this goal in 10 years will require:

More than doubling domestic production by shifting about 3 percent

of American farmland to grow more valuable fruits and vegetables.

Expanding production, processing and distribution in many regions

of the country to adapt to climate change and limited water

resources.

Reducing the cost of fruits and vegetables through changes in

federal programs so more farmers can grow more valuable fruit and

vegetables alongside other commodity crops.

Reducing food lost to spoilage by shortening the time from harvest

to sale, which also increases availability and reduces cost.

31 Harris: A Nielsen Company, The Harris Poll, 2013. http://www.harrisinteractive.com/NewsRoom/HarrisPolls/tabid/447/ctl/ReadCustom%20Default/mid/1508/ArticleId/1349/Default.aspx


Harvesting the Results

Increasing fruit and vegetable consumption to 4½ cups per

day within the next 10 years benefits our nation’s health, our

economy and our planet. This single change also represents a unique

opportunity to deliver these benefits while reducing economic and

environmental costs compared to many other proposals for reducing

disease, addressing climate change or ensuring water supplies.

Improvement in our nation’s health.

Dietary risks are the leading cause of disease burden in the

U.S. and also the leading cause of preventable death, accounting

more than a quarter of all deaths per year, a total of more than

678,000. 32 People who eat recommended levels of fruits and

vegetables have 20 percent lower rates of cardiovascular diseases

and stroke, as well as lower levels of diabetes.33 34 While current

comparative studies confirm the benefits of more fruits and

32 The State of US Health, 1990-2010: Burden of Diseases, Injuries, and Risk Factors US Burden of Disease Collaborators, JAMA. 2013;310(6):591-606. doi:10.1001/jama.2013.13805 33 He, F.J., et al., Increased consumption of fruit and vegetables is related to a reduced risk of coronary heart disease: meta-analysis of cohort studies. J Hum Hypertens, 2007. 21(9): p. 717-28. 34 He, F.J., C.A. Nowson, and G.A. MacGregor, Fruit and vegetable consumption and stroke: meta-analysis of cohort studies. Lancet, 2006. 367(9507): p. 320-6

Plant more value fruit and vegetable crops on 15.3 million acres of farmland instead of lower valued grains and seeds

Change What Grows on 3.5% of US Farmland

Reduce Loss from Spoilage

Shorten me from harvest to sale to increase availability and profitability while reducing costs

Expand Produc on and Distribu on

Expand produc on and distribu on capacity into new regions that are less suscep ble to severe weather and water scarcity.

Eliminate Federal Policy Obstacles

Allow farmers to grow fruits and vegetables alongside other crops without giving up federal supports and incen ves.


vegetables, current epidemiologic findings cannot confirm when the

same benefits might be realized in populations that change their

diets. However, even a 5 percent to 10 percent reduction in the

instances of cardiovascular diseases, stroke and diabetes represent

significant public health benefits, resulting in between more than

39,000 and nearly 80,000 avoided deaths and could be as much as

2.2 million and 4.43 million less cases suffering from these diseases.

Rates of Death from Dietary Risk

Disease Deaths 5% Reduction 10% Reduction

Cardiovascular Diseases

596,577 29,829 59,658

Stroke 128,932 6,447 12,893

Diabetes 73,831 3,692 7,383

Total Avoided Deaths

__ 39,967 79,934

Disease Due to Dietary Risk (2008-2010)

Disease Number of Cases35

5% Reduction In Cases

10% Reduction In Cases

Heart Diseases 19.4, million 970,000 1,940,000

Stroke 3.7 million 185,000 370,000

Diabetes 21.2 million 1,060,000 2,120,000

Total Avoided Cases of Disease*

__ 2,215,000 4,430,000

*Assuming no comorbidities.

35 Chatterjee, Anusuya , Kubendran, Sindhu , King, Jaque , and DeVol, Ross, Checkup Time: Chronic Disease and Wellness in America,Jan 29, 2014, http://www.milkeninstitute.org/publications/view/618


Economic benefits.

This economic return benefits three major parts of the nation’s

economy:

Lower healthcare costs.

The annual reduction in medical treatment costs from a 5 percent to

10 percent reduction in heart disease, stroke and diabetes would be

between $7.6 billion and $15.3 billion per year.

Avoided Medical Treatment Costs (2008-2010)

Disease Cost of Treatment Per Person/Year36

Avoided Cost from a 5% Reduction in Cases

Avoided Cost from a 10% Reduction in Cases

Heart Diseases $4,506.30 $4,371,111,000 $8,742,222,000

Stroke $5,400.80 $999,148,000 $1,998,296,000

Diabetes $2,147.70 $2,276,562,000 $4,553,124,000

Total Avoided Cost of Treatment

__ $7,646,821,000 $15,293,642,000

Reduced indirect economic burden due to higher rates of workforce

productivity.

Employees suffering from ailments miss workdays, a situation

known as absenteeism, or perform far below their potential, which

is called presenteeism. Informal caregivers for such patients also

experience absenteeism and presenteeism. As a result, businesses

suffer and the productivity of the entire economy declines, along

with GDP. The decline in GDP can have future negative

implications. So, along with measuring healthcare cost associated

36 Chatterjee, Anusuya , Kubendran, Sindhu , King, Jaque , and DeVol, Ross, Checkup Time: Chronic Disease and Wellness in America,Jan 29, 2014, http://www.milkeninstitute.org/publications/view/618


with a disease, an evaluation of the indirect economic burden of

disease should incorporate the broader effects of premature death

and diminished capacity of patients and caregivers to contribute to

economic growth. Improved quality of life and higher survival rates

due to more fruits and vegetables consumption contribute to

significant economic gains. A sizable amount of survivors will

return to workforce at some point and contribute to economic

growth (through increase in GDP).

Lower costs to reduce greenhouse gas emissions.

Shifting dietary intake to increase fruit and vegetable consumption

and reducing consumption of animal proteins, including red meats,

significantly reduces associated greenhouse gas emissions,

including the impact of growing crops for animal feed.

Increasing fruit and vegetable consumption to 4½ cups per day

while reducing protein consumption to the Recommended Daily

Allowance and maintaining the current mix of protein sources

would avoid over 400 million kilograms of CO2-equivalent

emissions37, representing a current value of over $4.9 billion.38

This reduction equals about 23 percent of current U.S.

greenhouse gas emissions-reduction targets. However, investment

to achieve these reductions are modest by comparison, involving

replanting 3 percent of U.S. farmland, improving produce supply

chain efficiencies, and reworking agriculture policies while

maintaining current incentives and supports. And these costs are

quickly recouped through avoided healthcare costs as compared to

37 Gardner, Christopher and Wasserman, Arlin, Protein, presented at the Stanford Medical School Food Summit 5, October 29, 2014. 38 Value of emissions reduction based on value of carbon emissions allowance traded on the Intercontinental Exchange, priced as of December 12, 2014. http://calcarbondash.org


other strategies to achieve these reductions including paying to

install emission control devices in power generation facilities,

switching fuel sources, and retrofitting existing buildings.

Increased profits from reducing waste from the spoilage.

Improvements to processing and distribution will shorten the

time from harvest to sale, reducing the amount of food loss from

spoilage, increasing the availability of fruits and vegetables, and

reducing their cost. The U.S. Department of Agriculture Economic

Research Services estimates grocery retails discard 8 percent 9

percent of fruits and vegetables they purchase for sale and

consumers discard 19 percent of fruits and 22 percent of vegetables

they buy. This represents 35.3 billion pounds of fruits and

vegetables lost, valued at approximately $49.8 billion. Some food

loss is inevitable, but the potential savings from shortening the time

from harvest to sale remain significant.39

The triple bottom line

The “triple bottom line” perspective shows that a diet

including a higher level of fruit and vegetables improves the health

of people, the economy and the environment. This includes at least

39,900 avoided deaths, about 2.2 million fewer illnesses, 400

million tons of avoided greenhouse gas emissions and over $7.6

billion per year in healthcare savings.

39 Buzby, Jean. C., Wells, Hodan Farah, and Bentley, Jeanine, ERS’s Food Loss Data Help Inform the Food Waste Discussion, U.S. Department of Agriculture Economic Research Service, Amber Waves. http://www.ers.usda.gov/amber-waves/2013-june/ers-food-loss-data-help-inform-the-food-waste-discussion.aspx#.VI2s6cZ-1MY


The Triple Bottom Line Benefit (Environmental impact includes food waste)

The Value of Coordinated Efforts

The American Heart Association’s initiative to engage with

leaders representing the entire food chain – including sectors such

as healthcare, environment, conservation, private investment, food

and agriculture – represents the intentional alignment and

coordination of efforts needed to realize true benefits of increasing

fruit and vegetable consumption over the next decade.

Healthier People

Avoided Treatment Costs

Food Waste

Value

CO2

•39,000 avoided deaths•2.2M avoided illnesses

•$7.6-$15.3B

•Fruits &Vegetables Share $49.8B

•400M Tons•$4.9B


Contributors:

Lawrence J. Appel, M.D., M.P.H.

Director of the Welch Center for Prevention, Epidemiology & Clinical Research

Johns Hopkins School of Medicine

Anusuya Roy Chatterjee, Ph.D.

Managing Economist

Milken Institute

William Dietz, M.D., Ph.D.

Director of the Sumner M. Redstone Global Center for Prevention & Wellness

George Washington University

Emily Ann Miller, M.P.H., R.D.

National Program Lead, Sodium Reduction Initiative, Preventive Health Markets

American Heart Association

Jeffrey O’Hara. Ph.D.

Agricultural Economist, Food & Environment Program

Union of Concerned Scientists

Dorothea K. Vafiadis, M.S., FAHA

National Director, Healthy Living

American Heart Association

Arlin Wasserman

Partner

Changing Tastes

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